The staging of Hodgkin's disease. Preoperative clinical assessment versus operative evaluation

Fifty consecutive patients with the diagnosis of Hodgkin's disease, confirmed by lymph node biopsy, underwent preoperative clinical assessment and staging laparotomy between 1969 and 1974. Preoperative evaluation consisted of bone marrow examination, liver and spleen scans, intravenous pyelograms, lymphangiograms, and standard chemical laboratory tests. Operative evaluation consisted of splenectomy, liver biopsy, periaortic, mesenteric, and celiac lymph node biopsy, appendectomy, and iliac crest bone biopsy. Twenty-three patients (46 per cent) were improperly staged by preoperative clinical assessment, with twelve patients being overstaged and eleven patients being understaged. Liver and spleen scans, and intravenous pyelograms were of little value in assessing organ involvement with Hodgkin's disease. Lymphangiograms similarly were of questionable value, being interpreted as positive in twenty-one patients but histologically involved in only seven patients (overread, 67 per cent. Fourteen patients had negative lymphangiograms, with five being histologically involved (underread, 36 per cent). There was a 22 per cent incidence of pulmonary complication (atelectasis, pneumonitis) but no deaths or life-threatening complications.